Clinical Profile And Outcome Of Patient With Acute Respiratory Distress Syndrome In Intensive Care Unit-A One Year Hospital Based Cross Sectional Study

Abstract

INTRODUCTION: Acute respiratory distress syndrome (ARDS) can be associated with significant morbidity and mortality among hospitalized patients. Although ARDS represents a complex syndrome with considerable morbidity and mortality, recent advances in clinical care have improved outcomes. Identification of subjects at high risk of developing mortality may aid the clinicians in efficient management of high risk cases and may reduce significant amount of mortality. Various risk scoring systems have been available for this purpose. There are retrospective studies on clinical course and outcome and only a few prospective studies in Indian literature. This study was a cross sectional prospective study where an attempt was made to study the clinical profile, and outcome of patients with ARDS admitted in ICU and the predictive validity of various scoring systems (SOFA, APACHE II AND APACHE III, qSOFA) in predicting mortality. MATERIALS AND METHODS This study was a cross sectional prospective study, conducted in the Intensive Care Unit (ICU), at KLES Dr.Prabhakar Kore Hospital and MRC Belagavi. All the eligible patients above 18 years admitted to the Intensive care unit and confirmed cases of ARDS based on the Berlin definition of ARDS were considered as study population. Patients with clinical or investigative procedures suggestive or left sided cardiac dysfunction and people with significant underlying lung disease were excluded from the study. All the patients have undergone appropriate imaging, biochemical and serological investigation to identify the etiology of ARDS. All the study participants were also evaluated at admission by APACHE II, APACHE III, SOFA, qSOFA score were computed for all. The utility of APACHE II& III in predicting outcome (improved Vs expired) was assessed by Receiver Operative curve (ROC) analysis. area under the ROC curve along with it’s 95% CI and p value are presented. P value < 0.05 was considered statistically significant. IBM SPSS version 22 was used for statistical analysis. RESULTS: A total of 60 subjects were included in the final analysis. The mean age of study population was 41.4 ± 14.51 with the ranged between 18 to 77 years. Among the study participants,34(56.7%) participants were males and remaining 26(43.3%) were females. Among the study population, 17(28.3%) participants had pneumonia. The number of OP poisoning, abdominal sepsis, dengue, H1N1, undiagnosed fever, pancreatitis, sepsis-chronic liver diseases, sepsis-intra uterine death, snake bite, UTI, leptospirosis, paraquat poisoning, acute fulminant viral hepatitis, malaria and scrub typhus was 6(10%), 3(5%), 5(8.3%), 5(8.3%), 4(6.7%), 3(5%), 4(6.7%), 2(3.3%), 2(3.3%), 2(3.3%), 1(1.7%), 1(1.7%) and 1(1.7%) respectively. The mean APACHE II score of study population was 16.9 ± 7.09 with the ranged between 2 to 35. The mean APACHE III score of study population was 71.58 ± 28.63 with the ranged between 10 to 139.The median SOFA score in the study population was 7.5(IQR:5,9)Out of 60 people, 18(30%) participants were intubated.Among the study population, 29(48.33%) participants had qSOFA score of 1, 27(45%) had q SOFA of 2 and 4 (6.67%) had qSOFA score of 3.In the study 75% study population was in sepsis. The mean mechanical ventilation days of study population was 5.08 ± 2.76 with the ranged between 2 to 14 days. The mean stay in hospital days of study population was 8.43 ± 4.06 with the range between 3 to 18. Days. The mean ICU stay of study population was 6.48 ± 3.04 with the ranged between 2 to 17 days. Among the study population 31(51.7%) participants had improved and 29(48.3%) participants had expired. The APACHE II score had excellent predictive validity in predicting mortality, as indicated by area under the curve of 0.933 (95% CI 0.857 to 1, P value <0.001). The APACHE III score had poor predictive validity in predicting expired, as indicated by area under the curve of 0.696 (95% CI 0.559 to 834, P value 0.010).The SOFA score had good predictive validity in predicting expired, as indicated by area under the curve of 0.871 (95% CI 0.779 to 963, P value <0.001) CONCLUSIONS: The study had concluded that APACHE II score had best predictive validity in predicting adverse outcome in patients with ARDS, followed by SOFA score. APACHE-III had poor predictive validity and q SOFA score may not be useful prediction too